Deformation Corrected Image Guided Laparoscopic Liver Surgery

总结 支持该应用的科学前提是与精确物理位置相关的技术 治疗和共同定位的空间编码疾病信息（即通常由成像提供）将使安全变得更加安全 侵入性较小的肝脏外科手术，从而增加手术候选资格并允许更准确 干预措施。更进一步，本地化方面的改进将有助于对结果进行分析 评估疗效、方法比较、改进评级以及影像学影响 驱动治疗决策的生物标志物。在此应用中，虽然存在潜在广泛的临床影响， 具体重点是促进和量化局部图像信息的空间准确性和保真度 增强腹腔镜肝脏手术期间的导航辅助。实现将是一个根本 程序医学领域的进步。应用假设是基于生物力学模型 配准与非接触式数字化相结合可以解释软组织变形并定位 肝实质内的目标是前所未有的平均误差小于 3 毫米。此外，我们 将开始探索这项技术对局部治疗的影响。这个应用程序还设置了什么 不同的是，通过我们提议的与 FDA 的整合，该技术的强大转化轨迹 清除肝脏引导系统。该应用程序的另一个区别是我们采用了评估 框架在纪念斯隆凯特琳医院招募了世界上最好的肝胰胆服务之一 癌症中心在 William R. Jarnagin 博士的监督下对该技术进行独立评估。 共同 PI 之间长达十年的合作关系非常富有成效（请参阅多 PI 计划） 是图像引导肝脏导航领域最具科学实质性的研究之一。具体目标 该应用涉及：(1) 将变形校正集成到商业制导系统中，(2) 对腹腔镜指征新方法的研究，其中包括非接触式技术的进步 充气建模、韧带支撑和模型异质性的数字化和新颖增强功能，(3) 三项临床旁观者研究定量描述了数字化和腹腔镜技术的改进 (4) 一项探索性研究，启动对本地区域平台使用情况的调查 疗法。总之，虽然该应用的重点是肝癌手术治疗的根本性进步， 它还通过在人类系统中提供一个新颖的研究框架来提供范式转变 的程序医学。

Summary The scientific premise underpinning this application is that technologies relating the precise physical location of therapy and co-located spatially-encoded disease information, i.e. usually provided by imaging, will enable safer less invasive liver surgical procedures thus increasing surgical candidacy and allowing for more accurate interventions. Going further, this improvement in localization will facilitate the analysis of outcomes for evaluating efficacy, the comparison of approaches, the rating of improvements, and the impact of imaging biomarkers to drive therapy decisions. In this application, while there is potentially broad clinical impact, the specific focus is facilitating and quantifying the spatial accuracy and fidelity of localized image-based information to enhance navigational assistance during laparoscopic liver surgery. Realization would be a fundamental advance in the domain of procedural medicine. The application hypothesis is that biomechanical model-based registration coupled to non-contact digitization can account for soft-tissue deformations and localize intraparenchymal liver targets to an unprecedented error of less than 3 mm of error on average. In addition, we will begin to explore the impact of this technology on locoregional therapies. What also sets this application apart is the strong translational trajectory of the technology through our proposed integration with the on FDA cleared liver guidance system. Another distinction for the application is that we have employed an assessment framework enlisting one of the best hepatopancreatobiliary services in the world at Memorial Sloan Kettering Cancer Center under the supervision of Dr. William R. Jarnagin for the independent evaluation of the technology. This decade+ long collaborative relationship among the co-PIs has been extremely productive (see Multi-PI plan) and is among the most scientifically substantive in the field of image guided liver navigation. The specific aims of the application involve: (1) the integration of deformation correction into a commercial guidance system, (2) the investigation of a novel approach to the laparoscopic indication which includes advances in a non-contact digitization and novel enhancements for modeling insufflation, ligament support, and model heterogeneity, (3) three clinical bystander studies that quantitatively characterize improvements in digitization, and the laparoscopic approach, and (4) an exploratory study that initiates the investigation of the use of the platform for locoregional therapies. In summary, while the focus of the application is a fundamental advance in liver cancer surgical care, it also offers a paradigm shift by providing a novel investigational framework in human systems within the context of procedural medicine.